Provider Demographics
NPI:1306276878
Name:CANTALUPO, CANDICE (LMT)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:CANTALUPO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SPINNAKER WAY
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-3331
Mailing Address - Country:US
Mailing Address - Phone:603-498-1278
Mailing Address - Fax:
Practice Address - Street 1:1 WEBB PL
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2456
Practice Address - Country:US
Practice Address - Phone:603-498-1278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3696M225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist